Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents. According to the latest epidemiological studies, the prevalence of ADHD in Chinese children and adolescents is as high as 6.4%[1]. The clinical manifestations of ADHD are age-appropriate inattention, reduced breadth of attention, hyperactivity in a variety of situations, impulsivity and associated learning difficulties. Besides, ADHD may be co-morbid with a variety of other types of psychiatric disorders, including conduct disorder, disruptive mood disorder, anxiety disorders, oppositional defiant disorder, etc.[2]. The symptoms and co-morbidities of ADHD can have a serious impact on a patient’s social functioning, and children and adolescents with ADHD have been reported to demonstrate low academic performance, experience poor interpersonal relationships and a significantly higher incidence of criminal behaviour such as intentional injury, drug abuse and robbery[3].
ADHD can also have a huge impact on family relationships. Compared to their normally developing peers, children with ADHD are often more challenging to their parents, more oppositional and in need of help and attention. Meanwhile, ADHD children's parents reported more pressure[4], which influenced their parenting styles. To illustrate, parents of children with ADHD have been found to adopt more negative and hostile parenting styles that are characterized by rejection and harsh disciplines, and are more condemning and less responsive to the child’s social activities[5].
Previous studies have highlighted the direct adverse effect of negative parenting styles on social functioning. Specifically, Western literature has found that supportive parent reactions improved children’s adaptive socialization strategies, whereas parental non-supportive reactions were associated with children’s impaired socialization[6–8]. However, the effect of parenting on children’s social functioning has been less predominant and more controversial in the Chinese cultural background. This may be explained by the relatively limited parental attention on the child’s social functioning development. To specify, contrasting with Western cultures, Chinese culture appears predisposed to perfectionism and uniform standards prompting individuals to compare themselves with each other. Within this logic, Chinese cultural backgrounds encourage competitive motivation rather than achievement motivation, promoting a controlling and coddling parenting model as the common pattern. Parents place great expectations on their children in terms of academic achievement and take great care of them in life, whereas children’s self-care social functioning receives much less attention compared to that in Western cultures. While Chinese children are motivated by external rewards such as good grades, they have limited opportunity to establish real emotional connections with their parents[9, 10]. Concerning empirical evidence, one study in Hefei[11] found no significant difference between positive, negative and moderate parenting styles on adolescents’ mental resilience, which contributes to intact social functioning[12, 13]. By contrast, another in-depth study on negative parenting styles in more economically advanced cities (Beijing, Shanghai, Hangzhou) in China highlighted the negative effect of over-protection and rejection parenting styles on individuals’ social adjustment[14].
Regarding children and adolescents with ADHD specifically, adverse effects of negative mothering and fathering on social adjustments were evidenced in a sample of Chinese children with and without persistent ADHD symptoms recruited in Taiwan, China [15, 16]. However, concerning the controversial findings within Chinese culture, despite the high cultural homogeneity between Taiwan province and mainland China, it remains unknown whether these findings are representative of mainland Chinese children and adolescents with ADHD. In addition, despite studies on social adjustments, no research to our knowledge has yet directly investigated children’s social functioning impairments with children and adolescents with ADHD. Meanwhile, there lack of in-depth research on the effect of each different type of parenting style, particularly positive parenting styles, on social functioning. Therefore, the first aim of the study is to examine the direct effect of different parenting styles on children’s social functioning impairments with a large and diverse sample of participants developing ADHD in mainland China.
Moreover, stressful life events that reflect children’s perception of their surroundings are also investigated for the indirect pathways of parenting styles and social functioning associations. Specifically, stressful life events in this study is defined as self-rated stressors, usually involving risk or readaptation to regular life, that are related to the onset and development of psychosis[17]. This variable is studied primarily taking into account that parenting styles have been widely found to influence the ability of children with ADHD to cope with stressful life events[18]. Particularly, based on the Chinese cultural contexts, parenting styles may further affect children’s social functioning impairments through children’s experience of stressful life events. To explain, under the controlling and coddling parenting model discussed above, Chinese children with ADHD are often subjected to harsher discipline, denial and scolding from their parents, because it is likely that their symptoms and related comorbidities would result in underperformance of these children in school settings, indicating failure to meet their parents’ expectations. Moreover, because of the general lack of parental guidance on self-care social functions in Chinese cultural background, they are unlikely to develop good independent problem-solving skills in daily life, have poor interpersonal skills and have low resistance to frustration. Taken together, a constant state of conflict where they want approval but never get it would be facilitated. Specifically, this state would be reflected by their perception of increased circumstances of negative life events. To illustrate, children with ADHD have reported experiences of more stressful life events than normally developing children[19] from childhood to adulthood[20]. Taking into account previous research on the adverse impact of stressful life events on social functioning[21], ADHD children and adolescents’ experience of stress through the conflicts may lead to further impairment of their social functioning. Hence, it is likely that stressful life events would play a mediating role between parenting styles and impairment in social functioning.
Overall, this study aims to examine the direct and indirect relationship between different types of parenting styles and impairment in social functioning in Chinese children and adolescents with ADHD. It is hypothesized that different parenting styles influence children and adolescents’ social functioning impairments, and that these effects are mediated by stressful life events.